Published: September 15, 2023

Focused Practice Designation (FPD) in Adult Complex Thyroid and Parathyroid Surgery

A new FPD for adult complex thyroid and parathyroid surgery will offer otolaryngologists the opportunity to demonstrate their particular interest and expertise.

Joseph Scharpf, MD, Elizabeth E. Cottrill, MD, Michael C. Singer, MD, Gregory W. Randolph, MD, William R. Blythe, MD, S. Mark Overholt, MD, Brian Nussenbaum, MD, MHCM, Brendan C. Stack, Jr., MD

The last several decades have seen a marked evolution in the performance of thyroid and parathyroid surgery. Thyroid and parathyroid surgery has increasingly come into the purview of otolaryngologists.

Although some otolaryngologists focus exclusively on neck endocrine surgery, this field represents a significant component of many comprehensive otolaryngology-head and neck surgery practices. A new focused practice designation (FPD) for adult complex thyroid and parathyroid surgery, which will be co-administered by the American Board of Otolaryngology – Head and Neck Surgery (ABOHNS) and the American Board of Surgery (ABS), will offer otolaryngologists the opportunity to demonstrate their particular interest and expertise in this area. Furthermore, obtaining the FPD will be evidence of the surgeon’s commitment to quality outcomes and focused education experiences.

Critically, thyroid and parathyroid surgery is, and will remain, within the scope of practice of ABOHNS diplomates certified in otolaryngology-head and neck surgery, even for those who decide not to attain this designation. FPD is a distinctly different process from subspeciality certification. Importantly, to be eligible to obtain a FPD a physician needs to have accumulated knowledge and expertise in an area through clinical experience, which may include but does not require fellowship training (Figure 1).

Figure 1. The FPD schema. Courtesy of Brian Nussenbaum, MD, MHCM, and Greg Ogrinc, MD, MS.Figure 1. The FPD schema. Courtesy of Brian Nussenbaum, MD, MHCM, and Greg Ogrinc, MD, MS.

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In 2019 the ABS and American Association of Endocrine Surgery (AAES) initiated a FPD for Comprehensive Endocrine Surgery in 2019. The ABOHNS, American Head and Neck Society, and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) requested to proceed collaboratively with the ABS/AAES to co-administer a FPD in adult complex thyroid and parathyroid surgery. A work group was assembled from stakeholder certifying boards and surgical specialty societies, including the ABS, AAES, ABOHNS, AHNS, and AAO-HNS. The members of that group were:

ABS: Peter Angelos, MD, PhD, Herb Chen, MD, Jo Buyske, MD
AAES: James Lee, MD, Kepal N. Patel, MD, Tracy Wang, MD, MPH 
ABOHNS: Jeffrey M. Bumpous, MD, David W. Eisele, MD, C. Gaelyn Garrett, MD, MMHC, Brian Nussenbaum, MD, MHCM
AHNS: Lisa A. Orloff, MD, Gregory W. Randolph, MD
AAO-HNS: David L. Steward, MD

This group and the FPD steering committee that was subsequently formed have now established eligibility criteria, agreed on continuing medical education requirements, and determined the value of an article-based knowledge assessment during continuing certification.

There are two pathways to obtain this FPD (Table 1). The practice component requirements can be decreased, but not eliminated, if one completes an accredited AHNS or AAES fellowship. The required cases include both core and complex cases. Core cases include thyroidectomy, parathyroidectomy, and neck dissection for thyroid cancer. Complex cases include substernal goiter, re-operative thyroid or parathyroid surgery, tracheal resection for thyroid malignancy, and management of anaplastic or medullary thyroid cancers.

Table 1. FPD requirements. Courtesy of Dr. Brian Nussenbaum.


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FPD renewal will be every five years. During this time, candidates must maintain good standing with their primary board certification and 60% of annual minimum CME requirements are required to be thyroid/parathyroid content. For example, of 25 CME credits, a minimum of 15 credits need to be thyroid/parathyroid content. Submission of new case logs will verify that the diplomate is still meeting FPD practice requirements. Candidates must obtain a passing score on an article-based knowledge assessment, focusing on clinical practice guidelines.

An exam committee has now been formed to define the scope of knowledge for the FPD, develop an exam blueprint and content, and create a path forward to the first exam. This initial exam may be given in 2025. The exam committee consists of diplomates from both the ABS and ABOHNS.